Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation

Watson, Scott; Schaller, Thomas M.; Tanner, Stephanie L.; Adams, John D.; Jeray, Kyle J.

doi:10.2106/jbjs.15.01093

Cited by 67 publications

(112 citation statements)

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“…The basicervical fracture line is the most significant feature of this cohort of patients. Strictly, a basicervical fracture is defined as a 2-part fracture where the fracture line originates from the base of the femoral neck and exits above the lesser trochanter [9]. Despite the concomitant PLF or LT fracture, the primary fracture lines in this cohort of patients met this description exactly.…”

Section: Discussionmentioning

confidence: 89%

“…There is little controversy about the fact that a basicervical fracture is an unstable fracture and prone to varus deformity [10]. Sliding screws were initially proposed as a treatment for these fractures [11,12], but the recent trend favors IN fixation [9,13]. Anatomically, the piriformis fossa is the transitional region between the hard cortex of the femoral neck and the relatively weak cancellous bone of the GT [14].…”

Section: Discussionmentioning

confidence: 99%

“…According to AO/ OTA classification (2018 version), AO-31A1 and A2 were designated as pertrochanteric fractures in which the main fracture line propagated through the trochanters. Saarenpaa, Watson and other authors described basicervical TF variant as fracture at the base of femoral neck that is medial to the intertrochanteric line [9,17,18]. So basicervical TF variant could not be classified into pertrochanteric (AO -31A1 and A2) or intertrochanteric fracture (AO -31A3).…”

Section: Discussionmentioning

confidence: 99%

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Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Zhang

2020

BMC Musculoskelet Disord

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Background: To introduce an unreported intraoperative complication in intramedullary nailing (IN) of an anatomically reduced trochanteric fracture variant characterized by a basicervical fracture line and coronally disrupted greater trochanter (GT). Methods: A total of 414 trochanteric fractures (TF) treated with intramedullary nails from 2013 to 2017 were included in this study. After analysis of intraoperative fluoroscopy data, 33 cases, including 21 females and 12 males, with a mean age of 72.5 years (33 to 96 years) were identified for internal rotation of the cephalocervical fragment and inferior opening at the basicervical fracture line caused by nailing a satisfactorily reduced TF. The morphological features of this group of patients were analyzed on computed tomography (CT) scan. On radiograph, the magnitude of the displacement and final femoral neck-shaft angle (NSA) were measured. Results: CT analysis demonstrated that the basicervical fracture line and the posterolateral fragment (PLF) detached from the GT were the two dominant features of this cohort. They were classified according to the number of main fragments: a 3-fragmentary subgroup containing three consistent fragments (cephalocervical fragment, PLF and distal femoral shaft) and a 4-fragmentary subgroup embracing one additional fragment (lesser trochanter). The four subtypes were as follows: the 3-fragmentary S indicating a small PLF (6 cases), the 3-fragmentary M presenting a moderate PLF (3 cases), the 3-fragmentary L standing for the PLF involving whole lesser trochanter (LT) (4 cases) and the 4-fragmentary GL incorporating separated PLF and LT fragments (20 cases). Geological analysis demonstrated that the majority of the basicervical fracture lines (81.8%) just crossed the center of the piriformis fossa, while the others marginally involved the medial wall of the GT. Postoperatively, the mean width of the inferior opening at the basicervical region was 9.2 ± 4.6 mm. The mean NSA was 135.2 ± 7.8 degrees. The comparison between the 3-and 4-fragmentary subgroups revealed no significant differences in magnitude of displacement and NSA. (Continued on next page)Conclusion: This unreported intraoperative complication predominantly occurred in the intramedullary nailed basicervical trochanteric fracture variant combined with a PLF from the GT. The magnitude of the secondary displacement was substantial and resulted in a relative valgus reduction. This secondary displacement was caused by an impingement of the reamer with the superolateral cortex of the cephalocervical fragment and should be addressed during the operation. Level of evidence: Therapy IV.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Zhang

2020

BMC Musculoskelet Disord

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“…Besides, neckshaft malreduction was another modifiable significant risk factor for cephalomedullary nail cutout in the treatment of trochanteric fractures [23]. Especially, these increased failure rates in helical blade use have been shown in the basicervical femoral neck fractures [22,24], although no single explanation for atypical cutout has been confirmed. The authors advocated the importance of fracture reduction in mitigating medial migration [21,25].…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series

Lin

Chou

et al. 2020

J Orthop Surg Res

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Background: Combined ipsilateral femoral neck and shaft fractures are an uncommon type of fractures. A number of different implant options are available for the management of this injury. Two-device procedures were suggested because of the higher rate of malunion by single-device treatment. However, surgical treatment using a cephalomedullary nail is still an alternative option that provides better mechanical advantage and minimal invasion. This study details the technique of treating these pattern fractures with proximal femoral nail anti-rotation II (PFNA-II) to achieve an acceptable reduction in both fracture sites. Methods: Ten cases of ipsilateral femoral neck and shaft fractures under reduction by PFNA II were included and reviewed. A saw-bone model was also utilized to perform the detailed technique of reduction and fixation of PFNA II. Results: Under the special technique by using the PFNA II, all ten cases achieved optimal reduction and alignment of both fracture sites in intra-operative fluoroscopy. There was no intra-operative complication noted. After 6 months of follow-up, radiography revealed proper alignment and well union of the fractures. Conclusions: Fixation of ipsilateral femoral neck and shaft fractures with a single construct provides advantages of good biomechanical function, minimal invasion, reduced blood loss, and less operation time when comparing to two-device fixation. Thus, if acceptable reduction could be achieved, fixation by one PFNA II was a good alternative choice for this injury pattern.

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“…Some studies have reported better results with the use of SHS in intertrochanteric fracture treatment and others have stated that CMN give better results (6)(7)(8). However, the current approach to the treatment of unstable intertrochanteric fractures is the use of CMN (9)(10)(11). It has been reported that basicervical fractures could also be evaluated as unstable fractures (12).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

Ecevız¹,

Çevi̇k²,

Bulut³

2020

Haseki

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Basicervical fractures of the femur are a unique type of unstable hip fracture, usually treated with sliding hip screw (SHS) or cephalomedullary nail (CMN). The aim of this randomized, prospective study was to evaluate the outcomes and complications of the two different treatment methods, SHS and CMN, in the management of basicervical fractures of the femur in the elderly osteoporotic bones. Methods: Patients aged over 65 years, who presented to our clinic with basicervical fracture of the femur between January 2016 and January 2018, were included in the study. The permuted block randomization method was used to randomize the participants into groups. The patients were allocated to one of two groups treated via CMN (n=29) or SHS (n=27). Functional and radiological evaluations included mobility score, Harris Hip score, modified Barthel index, Singh index, tip-apex distance, and fracture settling. Results: Continuous improvement in the Barthel index was seen over the 12-month period in either group (p<0.05). The average mobility score was found to be decreased at the 6 th week follow-up visits in either group (p<0.05). The fracture settling measurements in SHS group was higher than in CMN group (p<0.01). Conclusion: The clinical and radiological outcomes of both CMN and SHS groups showed no superiority of one technique over the other in the treatment of basicervical fractures of the femur.

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Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 67 publications

References 20 publications

Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Reverse wedge effect following intramedullary nailing of a basicervical trochanteric fracture variant combined with a mechanically compromised greater trochanter

Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series

Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

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